OP RHTE# %S -S- Harnett County Department of Public Health 23850
PERMIT #'t 51 0 Operation Permit
New Installation A Septic Tank A Nitrification line ❑ Repair ❑ Expansion
® a PROPERTY LOCATION: %—AuE.tLt:.;aGF- K
Name: (owner) �c~ZFSL7pt �+�+e'r�a/ �Gt-1� SUBDIVISION � 2^y c>mrlo a isLOT # �.
System Installer: LAa3�f 5 SjG Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well f Ob feet
System Type: ;TL e. Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
Ibis s mm hm been installed in compliance with applinble Nonh Carolina General Statutes. Rules for Sewage Treatment and Disposal, and all conditiom of the Improvement Permit and construction AuthorinUon.
� Lit S
� I
s
HC vs@
rr S�'MsJ�� Q
r Ltv� 1 1
_ V
PERMIT CONDITIONS
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting
❑
D -Box ❑
Pump ❑ Alarm ❑
H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal stem on the above captioned property.
Type of system:
El Conventional A Other
t i rLC G\)' 5 Septic Tank: 10 (s el
gallons Pump Tank: gallons
Subsurface
No. of
exact length width of
depth of
Drainage Field
ditches
of each ditch H 00 feet ditches 3
to
feet ditches O inches
French Drain Required: Linear feet
Authorized State Agent Date
Central. Carolina Holdings
Customer: 0369650001 / Larry Sharpes
Generator: NA / Not Applicable
Dest: DEST: CUSTOMER / Customer
Truck: LARRY SHAR
Comment:
Ticket: 891687
Date:1/8/2016
Time:O8:26:15 - 08:42:43
Scale
Gross: 45800 lb Out Manual Wt
Tare: 22040 lb In Manual Wt
Net: 23760 lb
Origin Wastes & Sevices Quantity Unit Rate/Unit Amount
------------------------------------------------------------------------------------------
NA / Not Applicable DFMT116/Drain Fill Material 11.88 TON $22.00/TN. $261.36
Total Taxes: $18.29
Total Amount: $279.65
Weighmaster: Driver:
Libby Cameron
This-ba�f tire chips is it � e! d log^,Qtion and meets the Nc specification as
stated in Tn� aste at r sys �6'V VVWS-2002-03R for tire chip
3abstit4tion for Rodk ggr4grote in NitrificationVFields.